Health QuestionsCategory: TreatmentsLithium vs. Anticonvulsants
Akathisia Sux asked 3 years ago

I have been on Trileptal for about 5 years.  Originally I was taking 600 mg per day and everything was going along just fine until a recent “breakdown” that has hospitalized me three times (I just got out today).  Now I am on 1200 mg per day, but my anxiety/mania symptoms seem to be as bad as ever.  I feel really good and hyper and cognizant of my surroundings and this usually leads, at night, into a full blown panic attack.  
 
My question is, I have read in some literature that Lithium was the first FDA approved drug for mania and that it is still considered, by most psychiatrists, to be the most effective.  Do you folks, in your non-medical opinion, think that I should ask my doc about getting on it in order to get these manias under control?
 
The weird thing is, my doc keeps wanting to increase my Zoloft (he wants me on 200mg a day) in order to stop these panic attacks, however, ADs can also swing one into mania.  So it appears to be a conundrum.  I wonder if I would be better off on just a mood-stabalizer by itself.  Does anyone have any experience with panic/mania and Lithium?
 
Thanks.

10 Answers
Glen answered 3 years ago

Re: Lithium vs. Anticonvulsants
Study these, and then ask your doc questions as to why he is not following the accepted guidelines.
 
http://www.psych.org/psych_pract/treatg/pg/bipolar_revisebook_index.cfm
 
http://www.canmat.org/resources/PDF/Bipolar_Guidelines.pdf

jookeyman answered 3 years ago

Re: Lithium vs. Anticonvulsants
I’m dx’d w/ BPI and Panic Disorder.
 
I take Lithium for BPI and Klonopin for Panic Disorder. It works o.k. but it doesn’t fully stop the mania. I take Risperdal and/or Seroquel for that. Still not a perfect fit but I get by (not in the hospital).
 
Jook
 
Almost forgot- I took 200 mg. Zoloft years ago for panic and it sent me into a mixed state. I’ve also been on 1200 mg. Trileptal monotherapy and it didn’t work. Maybe we’re cousins?

Akathisia Sux answered 3 years ago

Re: Lithium vs. Anticonvulsants
Glen,
 
I already have confronted my doc on the notion in psychiatry that it is never good to give AD’s to BP1 patients.  He, obviously, doesn’t see eye to eye with that paradigm.  He says if he took me off my AD’s I might “cut my wrist.”  He also said:
 
“Sure, that would work in a perfect world, but we dont have anyone to monitor you 24/7 to make sure that once you get off your Zoloft that you dont go kill yourself.”
 
Those were his words.  What to do?  He thinks I am a smart-ass for questioning his authority.  He is the doctor afterall.

Glen answered 3 years ago

Re: Lithium vs. Anticonvulsants
Quote from Akathisia Sux on 12. Sep 2006 at 22:16:

Glen,

I already have confronted my doc on the notion in psychiatry that it is never good to give AD’s to BP1 patients.  He, obviously, doesn’t see eye to eye with that paradigm.  He says if he took me off my AD’s I might “cut my wrist.”  He also said:

“Sure, that would work in a perfect world, but we dont have anyone to monitor you 24/7 to make sure that once you get off your Zoloft that you dont go kill yourself.”

Those were his words.  What to do?  He thinks I am a smart-ass for questioning his authority.  He is the doctor afterall.

 
Considering your major complaints are mania/anxiety I am at a loss as to why a potentially destabilizing agent is being increased while the most effective mood stabilizer is being ignored. Perhaps you could suggest to him that before raising the Zoloft you could try a low(ish) dose of Lithium (600mg)? I think that such an approach is much more consistent with current guidelines. Do you have any family that can help keep an eye on you?

Akathisia Sux answered 3 years ago

Re: Lithium vs. Anticonvulsants
Glen,
 
Your point is taken.  However, I have been suffering from what is probably best described as a dysphoric mixed state.  My moods are unpredictable and can change, literally, by the day.  The last time I saw my doc, when he suggested the Zoloft increase, I was very depressed about having to live my life in fear of these incessant panic attacks.  He then suggested that I get back in the hospital for monitoring during this Zoloft increase.  I did.  The docs in the hospital were not crazy about increasing from 100 to 200 all at once and wanted to titrate it slowly (125, 150, 175) etc…  Anyway I stayed four days in the hospital and then checked myself out against the doctor’s advice because if I had to paint another little toy car or sit through the SAME video on depression again I would have probably killed myself. Wink  Never, in any of my three recent hospital stays, have the docs suggested getting off Trileptal.  If I am having manic/anxiety symptoms, it seems reasonable to me to try another mood stabalizer.  
 
Now, I am on 80 mg of Geodon twice a day too.  Each hospital stay the docs increased it.  First it was 40, then 60, now they want me on 80.  The problem is, now I cannot sleep at night because I am having psychotic symptoms during sleep (yeah I know that sounds weird).  I am having horrifying dreams that are so bad that I don’t want to fall asleep.  In the state between sleep and consciousness (you know what I mean) I hear voices that aren’t there etc…  I have never done this in my life.  
 
I am at a loss of what to do.  After 3 hospitalizations and the addition of Geodon, I feel like I am not any better.

Akathisia Sux asked 3 years ago

I have been on Trileptal for about 5 years.  Originally I was taking 600 mg per day and everything was going along just fine until a recent “breakdown” that has hospitalized me three times (I just got out today).  Now I am on 1200 mg per day, but my anxiety/mania symptoms seem to be as bad as ever.  I feel really good and hyper and cognizant of my surroundings and this usually leads, at night, into a full blown panic attack.  
 
My question is, I have read in some literature that Lithium was the first FDA approved drug for mania and that it is still considered, by most psychiatrists, to be the most effective.  Do you folks, in your non-medical opinion, think that I should ask my doc about getting on it in order to get these manias under control?
 
The weird thing is, my doc keeps wanting to increase my Zoloft (he wants me on 200mg a day) in order to stop these panic attacks, however, ADs can also swing one into mania.  So it appears to be a conundrum.  I wonder if I would be better off on just a mood-stabalizer by itself.  Does anyone have any experience with panic/mania and Lithium?
 
Thanks.

3 Answers
Glen answered 3 years ago

Re: Lithium vs. Anticonvulsants
Study these, and then ask your doc questions as to why he is not following the accepted guidelines.
 
http://www.psych.org/psych_pract/treatg/pg/bipolar_revisebook_index.cfm
 
http://www.canmat.org/resources/PDF/Bipolar_Guidelines.pdf

jookeyman answered 3 years ago

Re: Lithium vs. Anticonvulsants
I’m dx’d w/ BPI and Panic Disorder.
 
I take Lithium for BPI and Klonopin for Panic Disorder. It works o.k. but it doesn’t fully stop the mania. I take Risperdal and/or Seroquel for that. Still not a perfect fit but I get by (not in the hospital).
 
Jook
 
Almost forgot- I took 200 mg. Zoloft years ago for panic and it sent me into a mixed state. I’ve also been on 1200 mg. Trileptal monotherapy and it didn’t work. Maybe we’re cousins?

Akathisia Sux answered 3 years ago

Re: Lithium vs. Anticonvulsants
Glen,
 
I already have confronted my doc on the notion in psychiatry that it is never good to give AD’s to BP1 patients.  He, obviously, doesn’t see eye to eye with that paradigm.  He says if he took me off my AD’s I might “cut my wrist.”  He also said:
 
“Sure, that would work in a perfect world, but we dont have anyone to monitor you 24/7 to make sure that once you get off your Zoloft that you dont go kill yourself.”
 
Those were his words.  What to do?  He thinks I am a smart-ass for questioning his authority.  He is the doctor afterall.

Glen answered 3 years ago

Re: Lithium vs. Anticonvulsants
Quote from Akathisia Sux on 12. Sep 2006 at 22:16:

Glen,

I already have confronted my doc on the notion in psychiatry that it is never good to give AD’s to BP1 patients.  He, obviously, doesn’t see eye to eye with that paradigm.  He says if he took me off my AD’s I might “cut my wrist.”  He also said:

“Sure, that would work in a perfect world, but we dont have anyone to monitor you 24/7 to make sure that once you get off your Zoloft that you dont go kill yourself.”

Those were his words.  What to do?  He thinks I am a smart-ass for questioning his authority.  He is the doctor afterall.

 
Considering your major complaints are mania/anxiety I am at a loss as to why a potentially destabilizing agent is being increased while the most effective mood stabilizer is being ignored. Perhaps you could suggest to him that before raising the Zoloft you could try a low(ish) dose of Lithium (600mg)? I think that such an approach is much more consistent with current guidelines. Do you have any family that can help keep an eye on you?

Akathisia Sux answered 3 years ago

Re: Lithium vs. Anticonvulsants
Glen,
 
Your point is taken.  However, I have been suffering from what is probably best described as a dysphoric mixed state.  My moods are unpredictable and can change, literally, by the day.  The last time I saw my doc, when he suggested the Zoloft increase, I was very depressed about having to live my life in fear of these incessant panic attacks.  He then suggested that I get back in the hospital for monitoring during this Zoloft increase.  I did.  The docs in the hospital were not crazy about increasing from 100 to 200 all at once and wanted to titrate it slowly (125, 150, 175) etc…  Anyway I stayed four days in the hospital and then checked myself out against the doctor’s advice because if I had to paint another little toy car or sit through the SAME video on depression again I would have probably killed myself. Wink  Never, in any of my three recent hospital stays, have the docs suggested getting off Trileptal.  If I am having manic/anxiety symptoms, it seems reasonable to me to try another mood stabalizer.  
 
Now, I am on 80 mg of Geodon twice a day too.  Each hospital stay the docs increased it.  First it was 40, then 60, now they want me on 80.  The problem is, now I cannot sleep at night because I am having psychotic symptoms during sleep (yeah I know that sounds weird).  I am having horrifying dreams that are so bad that I don’t want to fall asleep.  In the state between sleep and consciousness (you know what I mean) I hear voices that aren’t there etc…  I have never done this in my life.  
 
I am at a loss of what to do.  After 3 hospitalizations and the addition of Geodon, I feel like I am not any better.